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Development and validation of the Health Literacy Index for the Community for the Korean National Health and Nutrition and Examination Survey
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Junghee Yoon, Soo Jin Kang, Mangyeong Lee, Juhee Cho
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Epidemiol Health. 2024;46:e2024061. Published online July 10, 2024
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DOI: https://doi.org/10.4178/epih.e2024061
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 Abstract
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Abstract
OBJECTIVES
We developed and validated the Health Literacy Index for the Community (HLIC) to assess the health literacy of the Korean population within the framework of the Korean National Health and Nutrition and Examination Survey.
METHODS The HLIC was developed through (1) defining the conceptual framework and generating the item pool and (2) finalizing the items and identifying the cut-off value. Interviews were conducted to examine items’ face validity, and a cross-sectional survey was performed to analyze the item-response theory and Rasch models to investigate the instrument’s psychometric properties.
RESULTS In this study of 1,041 participants, most had no difficulty understanding health information; however, 67.9% struggled to assess the reliability of health information from the Internet or media. A 4-factor structure was identified through factor analysis, leading to the exclusion of some items. This resulted in 10 items across 4 domains: (1) disease prevention, (2) health promotion, (3) health care, and (4) technology and resources. The HLIC demonstrated good internal consistency, with a Cronbach’s α of 0.87. It also showed high test-retest reliability and correlations with other health literacy instruments. A socio-demographic analysis of the HLIC revealed disparities in health literacy across various age groups, education levels, and income brackets.
CONCLUSIONS The HLIC was developed to systematically measure health literacy in Korea’s general population. Its simplicity and conciseness ensure reliability and validity and improve its accessibility, making it particularly suitable for the broader Korean population, including those with lower literacy levels.
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Summary
Korean summary
본 연구는 한국인의 건강 문해력을 평가하기 위해 지역사회 건강정보 이해능력 측정도구(Health Literacy Index for the Community, HLIC)를 개발하고 검증하였다. 그 결과, 많은 사람들이 인터 넷이나 미디어에서 얻은 정보의 신뢰성을 평가하는 데 어려움을 겪고 있으며, 연령, 교육 수준, 소 득에 따라 건강정보 이해능력 격차가 존재함을 확인하였다. 특히 본 도구는 높은 신뢰도와 타당성 을 입증하였으며, 이를 통해 한국인의 격차를 파악하고 맞춤형 개입을 위한 중요한 정보를 제공하 는 도구로서의 유용성을 확인하였다.
Key Message
This study developed and validated the Health Literacy Index for the Community (HLIC) to assess the health literacy of Koreans, finding that many had difficulties to assess its reliability from Internet or media sources, and disparities in health literacy were observed across age, education level, and income. The HLIC demonstrated strong reliability and validity, highlighting its utility for identifying health literacy gaps and informing targeted interventions in Korea.
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